Provider Demographics
NPI:1932178381
Name:FITCH, ANDRIETTE MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:ANDRIETTE
Middle Name:MARTIN
Last Name:FITCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4336 NORTH BLVD.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BATON ROUGE
Mailing Address - State:LOUISIANA
Mailing Address - Zip Code:70806
Mailing Address - Country:UM
Mailing Address - Phone:225-383-3187
Mailing Address - Fax:225-383-3190
Practice Address - Street 1:4336 NORTH BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3920
Practice Address - Country:US
Practice Address - Phone:225-383-3187
Practice Address - Fax:225-383-3190
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA23650208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1484121Medicaid
LA1484121Medicaid
LAH48127Medicare UPIN
LA263720YH3VMedicare PIN
LA4A682CF44Medicare ID - Type Unspecified